Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Cardiovascular > Cardiac pharmacology and hypertension > Flashcards

Cardiac pharmacology and hypertension Flashcards

(79 cards)

Start Studying
1
Q

What is high BP a major risk factor for?

A

Stroke – ischaemic and haemorrhagic
Myocardial infarction
Heart failure
Chronic renal disease
Cognitive decline
Premature death
Increases the risk of: Atrial fibrillation (independent stroke risk)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Each 2 mmHg rise in systolic BP is associated with:

A

7% increased mortality from ischaemic heart disease

10% increased mortality from stroke
Continuous risk with increases in BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

When do you have suspected hypertension?

A

Clinic BP 140/90 mmHg or higher

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How are people with suspected hypertension confirmed to have hypertension?

A

ambulatory blood pressure monitoring (ABPM)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Stage 1 hypertension features?

A

140/90 Clinic BP
135/85 Ambulatory/Home readings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Stage 2 hypertension features?

A

160/100 Clinic BP
150/95 Ambulatory/Home readings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Severe hypertension features

A

Systolic BP 180/120
Diastolic PB 110

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the treatments for primary hypertension?

A

Lifestyle modification

Antihypertensive drug therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Who do we offer antihypertensive drug treatment too?

A

people aged under 80 years with stage 1 hypertension who have one or more of the following:

  1. Target organ damage
  2. Established cardiovascular disease
  3. Renal disease
  4. Diabetes
  5. A 10-year cardiovascular risk of 20% or greater.

Offer antihypertensive drug treatment to people of any age with stage 2 hypertension.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What do we target for therapy in BP control?

A

Cardiac output and Peripheral Resistance

Interplay between:
a. Renin-Angiotensin-Aldosterone system
b. Sympathetic nervous system (noradrenaline)

Local vascular vasoconstrictor and vasodilator mediators

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the most potent vasoconstrictor and main reason for increase in BP?

A

Angiotensin 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What does angiotensin 2 do?

A

1.Vascular Growth:
Hyperplasia
Hypertrophy

Salt retention
1. Aldosterone release
2. Tubular sodium reabsorption- kidney
3. Increase peripheral resistance and Cardiac output
4. act on sympathetic nerve ends to cause noradrenaline release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What does noradrenaline do?

A

Part of symapthetic ns

Increased renin production

Increases peripheral resistance and CO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What do ACE inhibitors do?

A

Block ACE, conversion from angiotensin 1 to angiotensin 2
Decrease BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What do ARB’s do? (Angiotensin receptor blockers)

A

Block angiotensin 2 on their receptors decreasing CO and PR
Block angiotensin 2 at receptor level
End in sartan
All very similar drugs
Widely used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What do calcium channel blockers do?

A

Act on PR receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What do beta blockers do?

A

block beta adrenoreceptors – have effect on cardiac output

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When are ACE inhibitors used?

A

Hypertension
Heart failure
Diabetic nephropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Examples of ACE inhibitors?

A

RAMIPRIL
PERINDOPRIL
ENALAPRIL
TRANDOLAPRIL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Side effects of Ace inhibitors?

A
  1. Related to reduced angiotensin II formation
    a. Hypotension
    b. Acute renal failure
    c. Hyperkalaemia
    d. Teratogenic effects in pregnancy
  2. Related to increased kinin production
    a. Cough
    b. Rash
    c. Anaphylactoid reactions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Main clinical indications for ARBs?

A

Hypertension
Diabetic nephropathy
Heart failure (when ACE-I contraindicated)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Examples of ARBs?

A

CANDESARTAN
VALSARTAN
TELMISARTAN
LOSARTAN
IRBESARTAN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Main side effects of ARBs?

A

Symptomatic hypotension (especially volume deplete patients)
Hyperkalaemia
Potential for renal dysfunction
Rash
Angio-oedema

Contraindicated in pregnancy
Generally very well tolerated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Main clinical indications of calcium channel blockers?

A

Hypertension
Ischaemic heart disease (IHD) – angina
Arrhythmia (tachycardia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Examples of calcium channel blockers?
AMLODIPINE NIFEDIPINE DILTIAZEM FELODIPINE LACIDIPINE VERAPAMIL
26
CCB: Dihydropyridines
nifedipine, amlodipine, felodipine, lacidipine affect vascular smooth muscle Peripheral arterial vasodilators
27
CCB: Phenylalkylamines
verapamil Main effects on the heart Negatively chronotropic, negatively inotropic
28
CCB: Benzothiazepines
diltiazem peripheral vascular effects
29
Side effects of CCB: Dihydropyridines
Due to peripheral vasodilatation (mainly dihydropyridines) Flushing Headache Oedema Palpitations
30
Side effects of verapamil
Due to negatively chronotropic effects (mainly verapamil/diltiazem) Bradycardia Atrioventricular block Due to negatively inotropic effects (mainly verapamil) Worsening of cardiac failure Verapamil causes constipation
31
Main clinical indications of beta adrenoreceptor blockers?
Ischaemic heart disease (IHD) – angina Heart failure Arrhythmia Hypertension
32
Examples of beta-adrenoreceptor blockers?
BISOPROLOL CARVEDILOL PROPRANOLOL METOPROLOL ATENOLOL NADOLOL
33
What drugs are B1 receptive?
Metoprolol Bisoprolol
34
What drugs are B1/B2 receptive?
Propanolol Nadolol Carvedilol
35
Half of receptors in heart are...
B2
36
What are the main side effects of of beta adrenoreceptor blockers?
Fatigue Headache Sleep disturbance/nightmares Bradycardia Hypotension Cold peripheries Erectile dysfunction
37
What do beta blockers worsen?
Asthma (may be severe) or COPD PVD – Claudication or Raynaud’s Heart failure – if given in standard dose or acutely
38
Main clinical indications of diuretics?
Hypertension Heart failure
39
What are the classes of diuretics?
Thiazides and related drugs (distal tubule) Loop diuretics (loop of Henle) Potassium-sparing diuretics Aldosterone antagonists
40
Examples of thiazide and related diuretics?
BENDROFLUMETHIAZIDE HYDROCHLOROTHIAZIDE CHLORTHALIDONE
41
Examples of loop diuretics?
FUROSEMIDE BUMETANIDE
42
Examples of potassium-sparing diuretics?
SPIRONOLACTONE EPLERENONE AMILORIDE TRIAMTERINE
43
Main adverse effects of diuretics
Hypovolaemia (mainly loop diuretics) Hypotension hypokalaemia hyponatraemia hypomagnesaemia hypocalcaemia Raised uric acid (hyperuricaemia – gout) Erectile dysfunction (mainly thiazides) Impaired glucose tolerance
44
A1 adrenoreceptor blockers?
Doxazosin
45
Centrally acting hypertenisves
MOXONIDINE METHYLDOPA
46
Direct renin inhibitor
ALISKIREN
47
Treatment steps for hypertension (Under 55 years)
1. ACE-inhibitor or Angiotensin II receptor Blocker 2. ACE-I / ARB + CCB 3. ACE-I / ARB + CCB + Thiazide-like diuretic 4. Resistant Hypertension Consider addition of Spironolactone, high dose thiazide-like diuretic, Alpha blocker, beta blocker, (others
48
Treatment steps for hypertension (Over 55 years or any AFRO-Carribbean age)
1. Calcium channel blocker 2. ACE-I / ARB + CCB 3. ACE-I / ARB + CCB + Thiazide-like diuretic 4. Resistant Hypertension Consider addition of Spironolactone, high dose thiazide-like diuretic, Alpha blocker, beta blocker, (others
49
What is LVSD?
Heart failure due to left ventricular systolic dysfunction
50
What is HFPEF?
Heart failure with preserved ejection fraction (diastolic failure)
51
What is heart failure?
Heart failure is a complex clinical syndrome of symptoms and signs that suggest the efficiency of the heart as a pump is impaired.
52
What is heart failure caused by?
It is caused by structural or functional abnormalities of the heart.
53
What is the most common cause of heart failure?
Coronary artery disease
54
What are the effects of heart failure?
Causes morbidity, mortality, hospital admissions and substantial cost
55
What is chronic heart failure due to?
Most of the evidence for pharmacology is in chronic heart failure due to LVSD
56
How can we help with chronic heart failure?
Main benefit is with vasodilator therapy via neurohumoral blockade (RAAS - SNS) and not from LV stimulants Heart is impaired therefore it affects circulation – response to that is sympathetic nervous system response – the RAAS system
57
What does aldosterone release do?
Increase sodium and water retention increasing BP Aldosterone antagonist stops this
58
Symptomatic treatment of congestion:
First line: ACE inhibitors and beta blocker therapy Low dose and slow uptitration Diuretic 2nd: Aldosterone antagonists – diuretics – stops sodium and water retention 3. Consider ARNI – Aldosterone receptor antagonist and Neprilysin inhibtitor 4. Consider SGLT2 inhibitor
59
What do you give if your ACE-I intolerant in congestion?
Angiotensin receptor blocker
60
What do you give if your ACE- I intolerant and ARB intolerant?
Hydralazine/nitrate combination
61
What can you also consider?
Consider digoxin or ivabradine
62
Nitrates
Arterial and venous dilators Reduction of preload and afterload Lower BP
63
Main uses of nitrates
Ischaemic heart disease (angina) Heart failure
64
Examples of nitrates?
ISOSORBIDE MONONITRATE GTN SPRAY GTN INFUSION
65
Coronary artery diseases
1.Chronic stable angina Anginal chest pain Predictable Exertional Infrequent Stable ************** 2. Unstable angina / acute coronary syndrome (NSTEMI) Unpredictable May be at rest Frequent Unstable ************** 3. ST elevation Myocardial Infarction (STEMI) Unpredictable Rest pain Persistent Unstable
66
Treatment for chronic stable angina
Immediate: GTN spray First line treatment: Beta blocker or Calcium channel blocker If intolerant: Switch If not controlled: Combine
67
Secondary treatment for chronic stable angina?
1. Antiplatelet therapy Aspirin Clopidogrel if aspirin intolerant 2. Lipid-lowering therapy Statins (simvastatin, atorvastatin, rosuvastatin, pravastatin)
68
If intolerant or uncontrolled what do you do?
Long acting nitrate Ivabradine Nicorandil Ranolazine
69
Treatment for Acute coronary syndromes (NSTEMI and STEMI)
1. Pain relief: GTN spray Opiates – diamorphine – heroin 2. Dual antiplatelet therapy: Aspirin plus ticagrelor or prasugrel or clopidogrel 3. Antithrombin therapy: Fondaparinux 4. Consider Glycoprotein IIb IIIa inhibitor (high risk cases): tirofiban, eptifibatide, abciximab 5. Background angina therapy: beta blocker, long acting nitrate, calcium channel blocker 6. Lipid lowering therapy: Statins 7. Therapy for LVSD/heart failure as required: ACE-I, beta blocker, aldosterone antagonist
70
Essential/primary hypertension:
accounts for 95% of hypertension. essentially means that the hypertension has developed on its own and does not have a secondary cause.
71
Secondary causes of hypertension:
ROPE Renal disease. This is the most common cause of secondary hypertension. If the blood pressure is very high or does not respond to treatment consider renal artery stenosis. O – Obesity P – Pregnancy induced hypertension / pre-eclampsia E – Endocrine. Most endocrine conditions can cause hypertension but primarily consider hyperaldosteronism (“Conns syndrome”) as this may represent 2.5% of new hypertension. A simple test for this is a renin:aldosterone ratio blood test.
72
Complications of hypertension:
Ischaemic heart disease Cerebrovascular accident (i.e. stroke or haemorrhage) Hypertensive retinopathy Hypertensive nephropathy Heart failure
73
What should patients with clinic BP between 140/90 mmHg and 180/120 mmHg have?
24 hour ambulatory blood pressure or home readings to confirm the diagnosis.
74
Having your BP taken by a doctor or nurse causes :
“white coat syndrome”. The white coat effect is defined as more than a 20/10 mmHg difference in blood pressure between clinic and ambulatory or home readings.
75
What should all patients with a new hypertension be tested for?
Urine: albumin:creatinine ratio for proteinuria and dipstick for microscopic haematuria to assess for kidney damage Bloods: for HbA1c, renal function and lipids Fundus examination: for hypertensive retinopathy ECG: for cardiac abnormalities
76
Medications for hypertension:
A – ACE inhibitor (e.g. ramipril 1.25mg up to 10mg once daily) B – Beta blocker (e.g. bisoprolol 5mg up to 20mg once daily) C – Calcium channel blocker (e.g. amlodipine 5mg up to 10mg once daily) D – Thiazide-like diuretic (e.g. indapamide 2.5mg once daily) ARB – Angiotensin II receptor blocker (e.g. candesartan 8mg to up 32mg once daily)
77
When are ARB’s used in place of ACE inhibitors?
if the person does not tolerate ACE inhibitors (commonly due to a dry cough) or the patient is black of African or African-Caribbean descent. ACE inhibitors and ARBs are not used together.
78
Spironolactone
potassium-sparing diuretic” that works by blocking the action of aldosterone in the kidneys, resulting in sodium excretion and potassium reabsorption. can be helpful when thiazide diuretics are causing hypokalaemia.
79
What does using spironolactone do?
Using spironolactone increases the risk of hyperkalaemia. ACE inhibitors can also cause hyperkalaemia. Thiazide like diuretics can cause also electrolyte disturbances. For this reason it is important to monitor U+Es regularly when using ACE inhibitors and all diuretics.

Cardiovascular (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions